Fall intervention programs in hospitals and nursing homes are performing poorly, and many patients and residents still fall in hospitals and injure themselves. One aspect of the patient's environment that has not been systematically evaluated as a trigger for falls, is the hospital bed. In our pilot research, bed height, instability of the side rails, and the lack of a handhold for use when exiting the bed all contributed to fall risk. In this proposed study we will examine the relationships between bed height, the configuration of side rails, patient's physical characteristics and biomechanical forces that are exerted as the patient climbs in and out of bed. Sixty four participants, recruited from acute and long term care settings, will be videotaped as they interact with a bed that has been instrumented to measure patient strength requirements. Biomechanical, observational, and subjective participant data will be used to determine the optimal hospital bed height and side rail configurations to minimize the risk of falling and reduce the risk of injury. The biomechanical data will include joint torque during bed entry, exiting, and in-bed repositioning, as well as physical interactions between the patient, floor surface and hospital bed. Observed problems such as slips, balance checks, incomplete entry/exit, and near falls will be coded. Participants will provide a subjective assessment of their perception of fall risk associated with different bed heights and side rail configurations. We will also examine the side rail use for in-bed mobility. The ultimate goal of this research program is to develop design recommendations for a hospital bed that will enable the patient to enter the bed safely, to reposition themselves with minimal exertion, to stand with minimal effort at the bedside, and to move away from the bed with an optimally stable gait. This proposed research project addresses AHRQ's Patient Safety Mission to study the comparative effectiveness of important existing health care technologies, in this case the hospital bed. The development of a safe hospital bed will conservatively reduce bedside falls by 10%, thereby saving the healthcare system costs estimated at $1.5 billion per year in the prevention of injury by 2020.